Surgery of the Wrist
Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou in Operative Orthopaedics, 2020
The APL and EPB tendons are mobilised and retracted. At this stage the surgeon may choose to identify and protect the radial artery to avoid injury during further exposure of the joint. This lies dorsally and may be retracted with use of a vessel loop taking care to cauterise any side branches. The presence of significant degenerative change may hamper easy identification of the trapezio-metacarpal joint. One way to overcome this is to apply axial traction to the metacarpal in order to correct the subluxation and uncover the joint that may be obscured by the metacarpal base. Again, a multitude of capsulotomies have been described, but a simple longitudinal capsulotomy is described here. Begin the capsulotomy with subperiosteal dissection at the metacarpal base – this will allow easier confirmation of the joint location. Continue the longitudinal capsulotomy to the level of the scapho-trapezial joint so that the proximal and distal margins of the trapezium are under direct vision. A combination of sharp dissection and the use of a periosteal elevator can allow for capsular flaps to be raised on either side of the arthritic joint. In order to aid this, a K-wire or corkscrew device may be placed into the trapezium in order to allow it mobilisation and retraction. The FCR tendon is well attached to the trapezium as it passed through a fibro-osseous tunnel on its volar aspect. Care must be taken during the dissection and during trapezial excision not to injure the FCR.
Implant-based whole breast reconstruction (with irradiation)
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava in Oncoplastic and Reconstructive Management of the Breast, 2020
Patients undergo total mastectomy and insertion of a tissue expander 3 to 4 weeks after the completion of chemotherapy. The expander is immediately placed in the submuscular plane at the time of total mastectomy. Approximately 50% of tissue expansion is performed intraoperatively. Complete musculofascial coverage is used and sentinel lymph node biopsy/axillary lymph node dissection is performed as appropriate. Rapid weekly expansion commences 10–14 days postoperatively, with the goal of achieving the final volume by 6 weeks postoperatively. At 8 weeks, with the tissue expander fully inflated, radiotherapy is administered to the chest wall and regional lymph nodes. Six months after radiotherapy is complete, an extensive capsulotomy is performed at the time of the exchange procedure, and the permanent device is subsequently inserted.
The Spastic Knee – Knee Flexion in Spastic Cerebral Palsy
Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel in Essential Paediatric Orthopaedic Decision Making, 2022
The knee flexion contracture can be addressed by serial stretch casting when mild. We utilise stretch casting for moderate to severe deformities with the goal of correcting the deformity to around −15 to –20° before osteotomy. We have no experience with posterior capsulotomy, but would anticipate that the risks of both nerve stretch injury and relapse would be higher than with osteotomy. Sciatic nerve injury is a risk with acute correction by capsulotomy or osteotomy.3 Most authors perform a distal femoral extension osteotomy often with shortening,3,5–9 and others have reported adequate correction with a shortening osteotomy alone.10 An increase in anterior pelvic tilt (4–10o) is a common finding after osteotomy7,8,10 even when an intramuscular lengthening of the iliopsoas was performed concomitantly.8
Early onset of capsular contracture after breast augmentation with implant: report of two cases & review of literature
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Subhi M. K. Zino Alarki, Hatan Mortada, Asma I. Abdullah, Hisham Alkhalidi, Musab Alrehaili
A 43-year-old female patient with a history of right breast cancer underwent right mastectomy and breast reconstruction with a Becker implant for eight years. No history of radiotherapy. She had implant exchange surgeries twice at different intervals previously. The last was on the 11 October 2020, as she was not satisfied with the right breast size with no other indications such as trauma or implant rupture. Therefore, the implant was exchanged with a 550-cc smooth Motiva® silicone implant and discharged afterward without any complications. A capsulotomy was done. Afterward, she presented to our clinic after nine weeks complaining of pain and redness over the right breast with a heaviness extending to the back and shoulder. On examination, the surgical site looked clean and healed—no noticeable discharge, signs suggesting undergoing infection or implant rupture (Figure 1).
Femtosecond Laser Assisted Cataract Surgery: A Review
Published in Seminars in Ophthalmology, 2021
The capsulotomy incision starts below the surface of the anterior capsule and continues through the capsule cutting in a cylindrical or spiral fashion.4,27 The Catalys initiates its capsulotomy incision at a depth of 0.6 mm whereas the Z8 initiates it at 0.8 mm. The VICTUS depth is unknown.2 The capsulotomy can be centered on the pupil center, pupil maximized center, scanned capsule (specific to Catalys), or custom placement. Bafna conducted a study comparing capsulotomy-IOL centration after scanned capsule versus pupil-centered capsulotomy, given the haptics make the IOL center within the bag itself naturally. In 82% of patients, the scanned capsule capsulotomy method offered better centration between the capsulotomy and IOL and 100% had 360 degree capsulotomy-IOL overlap.32 Kránitz et. al. found IOL decentration was six times more likely to occur in patients with a manual capsulorrhexis versus FSL capsulotomy.33 Centration is pivotal when creating capsulotomies for patients receiving multifocal and toric IOLs, as capsulotomy-IOL centration is key to their efficacy.
Correction of malrotation in two-stage breast reconstruction: outcomes and risk-factor analysis
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Jaemin Lee, Hyung Chul Lee, Seung-Ha Park, Seung Pil Jung, Eul-Sik Yoon
At our institution, the following three methods were applied to treat patients with implant malrotation: (1) manual reduction, (2) open reduction maintaining the previous implant, and (3) implant change to round type. Manual reduction was completed in the outpatient clinic. After reduction was conducted, further movement of the implant was checked with ultrasonography. The second method, surgical implant repositioning (Figure 2), involves a minimal surgical incision made in the operating room and repositioning of the implant. Adhesiolysis with capsulotomy and partial capsulectomy using breast endoscopy could be combined to prevent recurrence. This procedure was simple enough to complete under local anesthesia without admission. Massive irrigation was done and taping and garments were repeated strictly to prevent recurrence. The final method, implant change into the round type, aims to eliminate future malrotation issues (Figure 3). This procedure also could be completed successfully under both local and general anesthesia with or without capsulotomy.
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